Salud, género y reciclaje: un encuentro impostergable / Health, gender and recycling: a meeting that cannot be put off

Introducción. En Asunción existe una zona geográfica llamada Bañados, en esta zona se conforman los llamados «cinturones de pobreza», donde el trabajo informal se impone como principal medio de sustento. El oficio del reciclaje corresponde a uno de los trabajos informales más practicados. Objetivos. Describir aspectos de la zona donde desarrollan su vida trabajadora de la recolección. Incorporar elementos de resignificación positiva acerca del trabajo de reciclaje a mujeres recicladoras organizadas o no del Bañado Sur de la ciudad de Asunción, Paraguay. Material y métodos. Se realizaron 28 encuentros con 153 mujeres agrupadas en 7 grupos, durante el período del 2019 al 2022. La muestra fue seleccionada fue por conveniencia. Se eligió la modalidad de «taller» debido a las prácticas ya conocidas y aceptadas por la comunidad. Resultados. Se realizó conjuntamente la clasificación de la basura o residuos urbanos en sus categorías orgánica/inorgánica/tóxica, pero también en una clasificación más cercana a su realidad concreta. Se identificó cómo son las relaciones familiares y comunitarias, las preocupaciones por los hijos e hijas, el cambio climático, las inundaciones, las viviendas precarias, el acceso al agua, la inseguridad en el barrio y la problemática de drogas en la comunidad. Conclusión. Las jornadas se desarrollaron con mujeres recicladoras organizadas, miembros de una organización civil, que residen en el Bañado Sur – Tacumbú, Asunción (Paraguay). Durante el proceso se logró acercar a los grupos de mujeres que han podido participar de la experiencia, una resignificación positiva del trabajo y su rol en la sociedad, mediante el diálogo. (AU)

Introduction. In Asunción there is a geographic area called Bañados. They make up the so-called “poverty belts”, where informal work is laid down as the main means of support. The job of recycling is one of the most performed informal jobs. Aims. To report aspects of the area where collection workers go about their lives. Incorporate elements of positive new meaning about the recycling work to organized or disorganized women recyclers from Bañado Sur in the city of Asunción, Paraguay. Methods. In total 28 meetings were held with 153 women grouped into seven groups, during the period from 2019 to 2022. The sample was selected by convenience. The “workshop” modality was chosen due to the practices already known and accepted by the community. Results. Garbage or urban waste could be classified together in its organic/inorganic/toxic categories but also in a classification more akin to its specific reality. Family and community relationships, concerns for children, climate change, floods, precarious housing, access to water, insecurity in the neighbourhood and drug problems in the community were all identified. Conclusion. The sessions were held with organized women recyclers, members of a civil organization residing in Bañado Sur – Tacumbú, Asunción, Paraguay. During the process, it was possible to bring together the groups of women who were able to take part in the experience, a positive new meaning for work and their role in society, by means of dialogue. (AU)

Mindfulness para la reducción de síntomas de estrés, ansiedad y depresión en estudiantes universitarios de Yhú, Paraguay / Mindfulness for the reduction of stress, anxiety and depression in university students in Yhú, Paraguay

Introducción. El estrés, la ansiedad y la depresión son síntomas emergentes en estudiantes universitarios, por esto es vital para controlarlos identificar programas basados en evidencia, de bajo costo, y factibles de ser implementados y replicados en contextos naturalescomo las universidades. Objetivo.Evaluar el efecto de un taller introductorio a la práctica de mindfulness para la reducción de síntomas del estrés, ansiedad y depresión en estudiantes universitarios de la ciudad de Yhú en el periodo lectivo 2022. Materiales y métodos.Estudio cuasi-experimental en el que participaron en los talleres de mindfulness 20 estudiantes por ocho semanas. La escala estandarizada DASS21 se utilizó para la medición de estrés, la ansiedad y la depresión antes y después de la intervención; y la prueba de rangos con signo de Wilcoxon para muestras pareadas para determinar si había una diferencia en los datos previos y posteriores a la intervención en depresión, ansiedad y estrés. Resultados.Hubo diferencia significativa (p <0.001) en los puntajes pre-post de depresión, ansiedady estrés. Conclusión.Este estudio ha demostrado que las técnicas del mindfulness tienen una efectividad significativa en la reducción de síntomas de ansiedad, estrés y depresión en estudiantes universitarios. Serecomienda seguir evaluando el efecto del mindfulness con estudiantes universitarios, y la utilización de ensayos clínicos más complejos, y considerar además medir la validez social de las intervenciones a través de entrevistas o grupos focales con los participantes. Palabras Clave:ansiedad; depresión; mindfulness; estudiantes.

Introduction.Stress, anxiety and depression are emerging symptoms in university students; therefore,inorder to control them it is vital to identify programs based on evidence, at low cost, and feasible of being implemented and replicated in natural contexts such as universities. Objective.To evaluate the effect of an introductory workshop on the practiceof mindfulness for the reduction of symptoms of stress, anxiety and depression in university students from the city of Yhú in the 2022 academic year. Materials and methods.Quasi-experimental study in which 20 students participated in mindfulness workshops for eight weeks. The DASS21 standardized scale was used to measure stress, anxiety and depression before and after the intervention; and the Wilcoxon signed-rank test for paired samples to determine if there was a difference in pre-and post-interventiondata on depression, anxiety, and stress. Results.There was a significant difference (p < 0.001) in the pre-post scores of depression, anxiety and stress. Conclusion.This study has shown that mindfulness techniques are significantly effective in reducingsymptoms of anxiety, stress, and depression in university students. It is recommended to continue evaluating the effect of mindfulness with university students, and the use of more complex clinical trials, and also consider measuring the social validity of the interventions through interviews or focus groups with the participants.Key Words:anxiety; depression; mindfulness; students.

Motivos de internación en pacientes diabéticos en el Servicio de Clínica Médica del Hospital Regional de Ciudad del Este en el año 2016 / Reasons for hospitalization in diabetic patients in the Internal Medicine Service of the Regional Hospital of Ciudad del Este in 2016

Introducción: la diabetes mellitus (DM) es una enfermedad crónica no transmisible descripta desde la antigüedad en la cual se altera principalmente el metabolismo de los hidratos de carbono. Paraguay se enfrenta a un significativo déficit social en cuanto a los Objetivos del Desarrollo del Milenio. Los últimos datos sobre mortalidad son del año 2015, y la DM se ubica en segundo lugar como causa de muerte de la población general de 2013 a 2015. Objetivos: identificar los principales motivos de internación, y la distribución demográfica según sexo y edad de los pacientes diabéticos en el Servicio de Clínica Médica del Hospital Regional de Ciudad del Este, Paraguay, en el año 2016. Materiales y métodos: el estudio se realizó durante los meses de abril a octubre de 2018 en el Hospital Regional de Ciudad del Este. La población correspondió a todos los pacientes ingresados a la sala de internados del citado centro asistencial, en el período antes mencionado, con diagnóstico de DM corroborado por exámenes de laboratorio correspondientes. Se incluyeron todos los pacientes que cumplían con los criterios diagnósticos de DM: glicemia sérica igual o mayor a 126 mg/dl en ayunas, glicemia sérica mayor a 200 mg/dl en cualquier momento con síntomas clínicos de DM, y hemoglobina glicada>6,5%. Se excluyeron todos aquellos pacientes que no cumplían con dichos criterios. Resultados: se encontraron 245 pacientes con diagnóstico de DM de los cuales se incluyeron 241. La media de las edades de todos los pacientes fue de 59,92 años, la desviación estándar de 14,71, siendo la edad mínima de 15 años y la máxima de 90 años. Los pacientes que fueron admitidos por cuadros infecciosos fueron 126, lo que significó un 52% del total. Los pacientes ingresados por otras causas, que no fueran algún tipo de infección, fueron 115 pacientes lo que representó un 48%. Entre los pacientes ingresados por causas infecciosas y no infecciosas fueron discriminados otros subgrupos por sistemas afectados y etiologías. La principal causa de ingresos se encontró en las infecciones de piel y partes blandas con un total de 61 (25,3%), y fueron 43 (17,5%) los pacientes con infección del miembro inferior, de los cuales 22 (9,1%) presentaron pie diabético. Las causas menos frecuentes fueron las de los sistemas gastrointestinales, hematológicas y del sistema osteo artro-muscular, que contaron con un (0,4%) paciente cada una. Conclusiones: la principal causa de internación de personas diabéticas internadas en el Servicio de Clínica Médica en el año 2016 fue por infección de partes blancas con 61 pacientes (25,3%), y 43 (17,5%) de éstos por infección del miembro inferior y 22 (9,1%) por pie diabético. La determinación demográfica según sexo fue de 127 (53%) femenino y 114 (47%) masculino. La media de las edades de todos los pacientes fue de 59,92 años, la desviación estándar de 14,71, siendo la edad mínima de 15 años y la máxima de 90 años.

Introduction: diabetes mellitus is a chronic non-communicable disease described since ancient times, in which the metabolism of carbohydrates is mainly altered. Paraguay faces a significant social deficit regarding the Millennium Development Goals. The latest mortality data is from 2015, with diabetes mellitus in 2nd place as the cause of death of the general population from 2013 to 2015. Objectives: identify the main reasons for hospitalization, and the demographic distribution according to sex and age of diabetic patients in the Medical Clinic Service of the Regional Hospital of Ciudad del Este, Paraguay, in the year 2016. Materials and methods: the study was carried out during the months of April to October 2018, at the Regional Hospital of Ciudad del Este. The population corresponded to all patients admitted to the inpatient ward of the aforementioned healthcare center in the aforementioned period with a diagnosis of DM corroborated by corresponding laboratory tests. All patients who met the diagnostic criteria for diabetes were included: fasting serum glucose equal to or greater than 126 mg/dl, serum glucose greater than 200 mg/dl at any time with clinical symptoms of diabetes and glycated hemoglobin> 6.5 %. All those patients who did not meet these criteria were excluded. Results: 245 patients with a diagnosis of diabetes were found, of which 241 were included. The mean age of all patients was 59.92 years, the standard deviation was 14.71, with the minimum age being 15 years and the maximum age of 90 years. 126 patients were admitted for infectious conditions, which represented 52% of the total. The patients admitted for other causes, other than some type of infection, were 115 patients, which represented 48%. Among the patients admitted for infectious and non-infectious causes, other subgroups were discriminated by affected systems and etiologies. The main cause of admission was found in skin and soft tissue infections with a total of 61 (25.3%), and there were 43 (17.5%) patients with lower extremity infection, of which 22 (9,1%) had diabetic foot. The less frequent causes were those of the gastrointestinal, hematological and osteoarthro-muscular systems, which had 1 (0.4%) patient each. Conclusions: the main cause of hospitalization of diabetic patients admitted to the Medical Clinic Service of the Regional Hospital of Ciudad del Este in 2016 was due to infection of white parts with 61 patients (25.3%), of which 43 (17.5%) of these due to lower extremity infection and 22 (9%) were due to diabetic foot. The demographic determination according to sex was 127 (53%) female and 114 (47%) male. The mean ages of all patients was 59.92 years, the standard deviation of 14.71; being the minimum age of 15 years and the maximum of 90 years

Cost-Effectiveness Analysis of Pneumococcal and Influenza Vaccines Administered to Children Less Than 5 Years of Age in a Low-Income District of Bogota, Colombia.

BACKGROUND: The Colombian health authorities introduced the pneumococcal conjugated vaccine and the seasonal influenza vaccine into the national immunization schedule for children in 2009 and 2007, respectively. Despite this, the health authorities continue to be concerned about the high economic and disease burden among children from low-income households caused by these vaccine-preventable diseases. OBJECTIVES: 1) To evaluate the potential health outcomes of four vaccination strategies for subsidized children younger than 5 years in a low-income district in Colombia from a public, direct medical health care perspective. 2) To perform univariate, multivariate, and probabilistic sensitivity analysis to evaluate the robustness of these results. METHODS: We built a Markov deterministic cohort model to evaluate five consecutive cohorts across four alternative situations: 1) no vaccination; 2) vaccination with the 10-valent pneumococcal conjugate vaccine (PCV10 vaccine); 3) vaccination with the trivalent inactivated vaccine (TIV) annually; and 4) combined vaccination with PCV10 vaccine and TIV. RESULTS: The introduction of PCV10 vaccine and TIV and their combined use in particular would be highly cost-effective in comparison to no vaccination. For the combined vaccination with PCV10 vaccine and TIV, the incremental cost-effectiveness ratio would be $1,280 per disability-adjusted life-year (DALY) averted, the total incremental cost of the vaccination program would be $776,800, and it would avert four deaths and 332 DALYs for the five cohorts. CONCLUSIONS: The introduction of PCV10 vaccine and TIV would be highly cost-effective from a public, direct medical health care perspective. Despite these results, we have not observed decreases in severity or hospitalizations. Our findings highlight the need for further studies of the immunization campaign indicators and socioeconomic indicators for this low-income community.

The New Red Algal Subphylum Proteorhodophytina Comprises the Largest and Most Divergent Plastid Genomes Known.

Red algal plastid genomes are often considered ancestral and evolutionarily stable, and thus more closely resembling the last common ancestral plastid genome of all photosynthetic eukaryotes [1, 2]. However, sampling of red algal diversity is still quite limited (e.g., [2-5]). We aimed to remedy this problem. To this end, we sequenced six new plastid genomes from four undersampled and phylogenetically disparate red algal classes (Porphyridiophyceae, Stylonematophyceae, Compsopogonophyceae, and Rhodellophyceae) and discovered an unprecedented degree of genomic diversity among them. These genomes are rich in introns, enlarged intergenic regions, and transposable elements (in the rhodellophycean Bulboplastis apyrenoidosa), and include the largest and most intron-rich plastid genomes ever sequenced (that of the rhodellophycean Corynoplastis japonica; 1.13 Mbp). Sophisticated phylogenetic analyses accounting for compositional heterogeneity show that these four "basal" red algal classes form a larger monophyletic group, Proteorhodophytina subphylum nov., and confidently resolve the large-scale relationships in the Rhodophyta. Our analyses also suggest that secondary red plastids originated before the diversification of all mesophilic red algae. Our genomic survey has challenged the current paradigmatic view of red algal plastid genomes as "living fossils" [1, 2, 6] by revealing an astonishing degree of divergence in size, organization, and non-coding DNA content. A closer look at red algae shows that they comprise the most ancestral (e.g., [2, 7, 8]) as well as some of the most divergent plastid genomes known.

Disease burden and medical cost-analysis of acute respiratory infections in a low-income district of Bogotá / Análisis del costo médico y la carga de enfermedad de las infecciones respiratorias agudas en una localidad de ingresos bajos de Bogotá

Objective To estimate the burden of disease and related direct medical cost of Acute Respiratory Infections (ARI) for the health-care system in a low-income district of Bogota, generated by children under age five and senior population over age sixty. Methods A cross-sectional, retrospective, patient level study was conducted in San Cristobal district from 2008 to 2012 among the subsidized population. All inpatients and outpatients with ARI from three hospitals were reported. The total and average direct medical costs were estimated and are reported in International Dollars (Int$). Results It is estimated that, for children, ambulatory incidence rate for ARI varied between 54.4 % and 66.3 % and hospitalization rate between 9.2 % and 12.3 %. The mortality rate in the district oscillated between 18.1 and 27.7 deaths per 100 000. The main medical costs were attributed to hospitalizations, and the total medical hospitalization cost per year estimated ranged between Int$ 1 334 352 and Int$ 2 139 597. In the case of senior population, the ambulatory incidence rate fluctuated between 7.6 % and 10.0 %, and the hospitalization rates between 0.6 % and 2.1 %; the mortality rate ranged between 8.9 and 47.8 deaths per 100 000. Hospitalization cost per year was estimated to be between Int$ 88 957 and Int$ 373 382. Conclusion Direct medical costs due to ARI have an important disease and direct medical cost burden in this low-income district.(AU)

Objetivo Estimar la carga de enfermedad y los costos médicos directos relacionados con las Infecciones Respiratorias Agudas (IRA) para el sistema de salud en una localidad de bajos ingresos de Bogotá, en niños menores de cinco años y adultos mayores de sesenta años. Métodos Se realizó un estudio retrospectivo transversal a nivel de paciente en la localidad de San Cristóbal desde 2008 y 2012 en la población subsidiada. Se reportaron todos los pacientes hospitalizados y ambulatorios de tres hospitales públicos debido a IRA. Se estimaron los costos médicos directos relacionados. Los costos fueron convertidos en dólares internacionales (Int$). Resultados En niños. Se estimó que la incidencia ambulatoria para IRA varió entre 54,4 % y 66,3 % y la tasa de hospitalización varió entre 9,2 % y 12,3 %. La tasa de mortalidad en el distrito osciló entre 18,1 y 27,7 muertes por 100 000 niños. Se estimó que el costo de las hospitalizaciones oscilaron anualmente entre Int$ 1 334 352 y Int$ 2 139 597 representado la más importante carga financiera. En adultos, la incidencia ambulatoria fluctuó entre 7,6 % y 10 %. Las tasas de hospitalización variaron entre el 0,6 % y el 2,1 %. Mientras que la tasa de mortalidad varió entre 8,9 y 47,8 muertes por 100 000. Para hospitalizaciones se estimó un costo total por año entre Int$ 88 957 y Int$ 373 382. Conclusión Los costos médicos debido a IRA tienen una carga económica importante para el sistema de salud y los hogares en esta localidad.(AU)

Disease burden and medical cost-analysis of Acute Respiratory Infections in a low-income district of Bogotá.

Objective To estimate the burden of disease and related direct medical cost of Acute Respiratory Infections (ARI) for the health-care system in a low-income district of Bogota, generated by children under age five and senior population over age sixty. Methods A cross-sectional, retrospective, patient level study was conducted in San Cristobal district from 2008 to 2012 among the subsidized population. All inpatients and outpatients with ARI from three hospitals were reported. The total and average direct medical costs were estimated and are reported in International Dollars (Int$). Results It is estimated that, for children, ambulatory incidence rate for ARI varied between 54.4 % and 66.3 % and hospitalization rate between 9.2 % and 12.3 %. The mortality rate in the district oscillated between 18.1 and 27.7 deaths per 100 000. The main medical costs were attributed to hospitalizations, and the total medical hospitalization cost per year estimated ranged between Int$ 1 334 352 and Int$ 2 139 597. In the case of senior population, the ambulatory incidence rate fluctuated between 7.6 % and 10.0 %, and the hospitalization rates between 0.6 % and 2.1 %; the mortality rate ranged between 8.9 and 47.8 deaths per 100 000. Hospitalization cost per year was estimated to be between Int$ 88 957 and Int$ 373 382. Conclusion Direct medical costs due to ARI have an important disease and direct medical cost burden in this low-income district.

Fever of unknown origin: keys to determining the etiology in older patients.

In light of improvements in imaging modalities and laboratory tests, fewer cases of fever of unknown origin (FUO) are being attributed to infectious causes and more are eventually being diagnosed as secondary to noninfectious causes, particularly tumors and connective tissue diseases. Older patients with FUO usually present with mild, nonspecific, normochromic, and normocytic anemia and an elevated erythrocyte sedimentation rate. The history, physical examination, and imaging studies are key to making a diagnosis. Although the results of laboratory tests are generally nonspecific, such tests are appropriate nonetheless. Obtaining repeat blood cultures is mandatory. However, before undertaking a diagnostic evaluation of geriatric FUO, it is important to consider the patient's overall health. In certain circumstances, it is more important to maintain a patient's quality of life than it is to initiate the process of identifying and treating a persistent fever. The work-up and treatment should not be worse than the disease.